Work

Progressive High-Grade Atrioventricular Block in a Young Adult: Distinguishing Reversible Causes From Lev-Lenègre Disease

Year: 2026

Type: article

Abstract: High-grade atrioventricular (AV) block in young adults is uncommon and poses a diagnostic challenge when distinguishing reversible causes from intrinsic conduction system disease. We present a 27-year-old previously healthy male who presented with dizziness and was found to have a complete heart block with a wide QRS escape rhythm requiring temporary pacing. Initial evaluation revealed metabolic abnormalities and positive Coxsackie serology; however, correction of these factors did not result in improvement of conduction. Echocardiography demonstrated a normal cardiac structure. Given the possibility of a reversible etiology, permanent pacing was initially deferred. Two months later, the patient re-presented with near-syncope and progression to bifascicular block with first-degree AV block, consistent with progressive His-Purkinje system disease. He subsequently underwent successful dual-chamber leadless pacemaker implantation with resolution of symptoms. This case highlights the importance of recognizing progressive conduction system disease, such as Lev-Lenègre disease, even in young patients with apparent reversible factors, and emphasizes the role of serial electrocardiographic evaluation in guiding timely management.

Source: Cureus

DOI: 10.7759/cureus.108608

Authors: Emanuel Zayas Diaz, Amarjit Kaur Sekhon, Hector Vega, Genesis J Mojica Sanchez, Shrilkumar Bhatt

Institution: Universidad Autónoma de Guadalajara

Language: English

Topic: Cardiac electrophysiology and arrhythmias

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7160772023